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Wednesday, September 17, 2014

Inventory Reduction

In pharmacy we must always be mindful of our inventory. We must improve our turns, keep inventory low, and order profit-friendly NDCs.
Manufacturers have these same issues.
When you market a "new" medication, you want it to be a game changer. You expect to sell it by the bushel. What if that doesn't happen?
You get this quick, witty conversation at work.

CP's Partner: Why did you run this through for the 30 count NDC?
CP: Because the Rx was written for 30 tablets and I don't think we'll use it again.
CPP: Great minds think alike.
CP: Indeed.
CPP: Only one problem.
CP: What's that?
CPP: They quit making the 30-count NDC.
CP: Of course.
CPP: We can only order the 90-count NDC now.
CP: Right. Well when you have a groundbreaking drug such as this you want to sell as much as you can.
CPP: Did you just call Gralise a "groundbreaking drug".
CP: I did.
CPP: Your cynicism just made me spit out my coffee.
CP: Thanks. Think about it. They took plain old Gabapentin, made an extended-release form of it and charged triple. No one prescribes it because it's rarely covered and the generic is much cheaper. Now how does a company with a failed brand get rid of their inventory? They package all their slow-moving product in larger bottles forcing pharmacies to order sizes they don't need. This puts the burden on the pharmacies to get rid of the inventory. Manufacturer's warehouses are emptier, product has been sold and paid for, profits improve. Pharmacies are stuck with partial bottles waiting to expire. Think of all those Duexis prescriptions we received.
CPP: Another fine groundbreaking drug.
CP: Indeed...Right you are, Ken...

Monday, September 15, 2014

Just Stop...

Change can be good. It can be difficult to accept at first. People are often resistant to new ways of thinking. Sometimes this is because they are accustomed to and comfortable with the old way. Sometimes they fight because they cannot see how the new way will be better than the old. The definition of insanity is doing the same thing over and over and over expecting a different result. What if we gave people no choice but to accept the "new normal"? Would civilization as we know it end? Would the markets crash? Would the world stop revolving? No. Life would go on as it always has after these Earth-shattering events. Now, how does this relate to pharmacy?

I was told by a corporate pharmacy suit that "as long as everyone else is doing it, we need to as well". He went on to say that "as long as we have a chip in the game we can sit at the table". Brilliant. This is the thinking that has advanced our profession backwards over the last couple decades.

Ideas: Stop all coupons. Stop all transfer incentives. Stop all gift cards. Stop all Perks programs. Stop using my profession to generate FE business. Better yet; get out of the FE business altogether. If you give a group of children 7 choices of flavors on anything, they cannot make a decision. Give them one option, or perhaps two, and they will make it quicker. Same with pharmacy. Remember when they took away all analog TV? People fought it, cried about it, government legislated on it and there were constant battles about it. Guess what happened? The day came, the switch was thrown, and nothing happened. It's a tough decision to get rid of one's security blankie, their lifesaver, teddy bear, or crutch. At some point, they have to learn to grow up and walk/survive without them. It's time for pharmacy corporations to man up and just not do it anymore. People complained, people got upset, people were revolting (some still are-wink wink). But they survived. I like it. I went shopping today and everyone was trying to figure out how to use coupons at the 3 places I visited. Some coupons weren't valid on certain products, at certain hours, on certain sizes, in combination with other offers, whatever. The point is, I spent more time waiting for people to use their coupons and figure out sales ads today than I did actually shopping for what I needed. Make it stop. The Profession of Pharmacy needs to go back to when it was respected as just that, a Profession.

If they want to focus on healthcare and the profession, I am all for ways to do it. I have no problems with immunizations, MTMs, clinics, etc in my pharmacies. Just focus the money from advertising and gift cards on adding support to facilitate these programs. I could do all of these more efficiently if you gave me extra help. We have no adaptability or flexibility. Our corporations are strictly dollars-and-cents types. First cuts are to labor. In the next breath it's improve your customer service. It's like telling a kid to keep clapping after cutting off one of his arms; cruel, yet somehow expected to work or he'll be put in timeout.

Seriously consider charging for everything. Doctors expect us to fax them refill requests? Charge for them. Patients expect us to call or fax for refill requests? Charge them. Prior Authorizations need faxed? That's a charge too. You need a few pills or you'll die over the weekend? There's a fee for that. I have a great post dedicated to nickel-and-diming doctors and patients over error-filled prescriptions. Time to revolutionize the industry. Get everyone on board. Change the game. The players will adapt. If everyone signs on, there will be no "well Wal-Mart doesn't do that so I'll go there". Make it the new pharmacy professional standard.

Friday, September 12, 2014

If Patients Treated Their Prescribers' Offices as They Treat Us...

... and I am certain they do. It is something we share. A common bond. Like a school shares germs and a lice outbreak. I would be interested in hearing how the conversations I have at the pharmacy sound at the office...

1.Just call in whatever you called in for me last time.
2. Just call it in wherever you sent it last time.
(I'll just go wherever I think that is anyway and yell at them.)
3. I don't know what it is. It's right there in my chart. Can't you just look it up?
4. What do you mean the pharmacy didn't fax you?! I was right there when she clicked "fax". She said she sent it. I watched her.
5. What do you mean I have to call my own pharmacy and have them request a refill? I'm standing right here!
6. I need everything refilled I've had prescribed over the last year. Yes. Of course I mean the yeast infection cream from last January! I said everything, didn't I? No. Not the inhaler stupid.
7. It's my pre-med! I need it now! My dentist appointment is right now and I was supposed to take this a half hour ago but you people didn't open until now so it's all your fault if I have to reschedule!
8. I've been on this for years. What do you mean "no refills until I come in for an appointment!"? He said I'd be on this until I die.
(Apparently he is trying to hasten my demise.)
9. What do you mean I have a $20 copay? Did you bill my insurance? Why the hell do I pay so much to have premium insurance if you're going to charge me $20 every time.
10. Well the other doctor I go to across town doesn't charge me anything.
11. My pharmacy said my office visit would be $4.
12. They said this exam was on your "Free" list.
13. What do you mean I have to wait for my appointment? There's no one here in this waiting room.
14. All you have to do is put me in a room and squeeze that little bulb thingy.
15. Wow. You guys must be slow today. There's no one here.
16. How long is this going to take? I just picked up ice cream from the grocery store and it's melting in my car.
17. I need the little white one, the oblong white one, the roundish off-white one, and some green or blue tablet or capsule or something plus my cream or ointment...or maybe the gel. <click>
18. No I do not have my insurance card with me. I've been coming here since before you were born.
19. No, I've never been seen but my husband has. It's all the same information.
20. Why do you need my date of birth? I'm not telling you that. That's private. You're going to steal my identity.

Receptionist: How may I help you?
Every Patient: I need to speak to the doctor.
Receptionist: Is there something I can help you with?
EP: No. I just need to speak to the doctor.
Dr. Zoffis: How may I help you?
EP: I need to schedule an appointment...

Receptionist: Ma'am, why are you ripping pages out of all our magazines?
Proactive Patient: I'm taking out all the drug ads so I know what to tell the doctor I need today.

Receptionist: <picks up phone> Hello?
PP: What's taking so long?
Receptionist: Are you calling me from the waiting room?
PP: Yes.

Thursday, September 11, 2014

If the Real World Worked the Way People Believe Pharmacy Does...IV

Crazy. But that's how it goes...I know that things are going wrong for me. You've gotta listen to my words...

Sprint Service: Thank you for calling the SS today, how may I help you?
CP: Yeah. I got this letter in the mail?
SS: That's a statement with a Canadian inflection at the end making it sound like a question. Do you have a question? Question mark?
CP: I got this letter and I want to know why you people sent it to me! Exclamation point!
SS: We send all types of letters to your house. Some are bills. Some are offers for new services. Some are advertisements for new phones.
CP: YOU people sent them to me. Why don't YOU know what it is?
SS: Our corporate sends those to households. They do not come from this local retail outlet. If you are a current customer you could receive every one of the mailings that go out across the country, including a bill or reminder that your contract is expired and needs renewed.
CP: Can't you just look it up?
SS: No. That's pretty much the point of sending the letter. To communicate a message to you in a readily retrievable form so we don't have to know why we contacted you.
CP: Well I didn't get the mail this morning so how am I supposed to know what it is? Someone told me there was mail from the SS on my counter and I want to know why!
SS: Do you have the mailing in front of you?
CP: Yes.
SS: Do you have a knife or letter opener with you?
CP: Yes.
SS: Carefully slide the knife along your jugular vein then stab yourself in the eye.
CP: How will that help?
SS: It will rather abruptly end this silly phone call.
CP: Sounds painful.
SS: Much like this phone call.
CP: Other options?
SS: Open. The. Letter...then Read. The. Letter.
CP: It says my contract needs renewed. Can you do that for me?
SS: No. You'll have to call the sales department for that.
CP: But Verizon called for me.
SS: I'm sure they did. This is not Verizon. This is Sprint. If you like their service and products better, perhaps you would be interested in contacting them.
CP: I don't understand. My pharmacy always calls my prescriber for me. They refill my prescriptions for me, they call me when they are ready to pick up, they do everything for me.
SS: This is the real world, not the pharmacy. We actually expect you to take care of your own life. You want a phone? You call the phone company. You want a cheeseburger? You drive to McDonald's. No one is going to randomly call you soliciting business and offering to do everything for you. There is no business called Let Me Be Your Bitch. No one does that.
CP: My pharmacy does.
SS: Your pharmacy is a whore.

Maybe I'm the one who is the schizophrenic psycho...

Wednesday, September 10, 2014

If the Real World Worked As People Believe Pharmacy Does...III

Bottle of white. Bottle of red. Perhaps a bottle of rose instead...I'll meet you any time you want, in our Italian restaurant...
Restaurant Host: How may I help you this evening?
CP: I am here to pick up a pizza that should have been ordered earlier.
RH: For what name?
CP: Pharmacist...Cynical Pharmacist.
RH: Charming. I am sorry, but I do not see an order for that name. What is your phone number?
CP: We have 7 phone numbers at the house. It could be any of these.
RH: Nope. I am sorry but we have not received an order yet.
CP: Can you check the voicemail?
RH: We don't have voicemail. We answer all our calls. 
CP: How about the fax or the computer? 
RH: Who uses a fax anymore? And our online order system is empty. 
CP: Can you check again?
RH: It is not here. There are the completed carryouts and to-go orders being made.
CP: How long is it going to take?
RH: For what?
CP: To make my order?
RH: I have to receive it first and as I've OVERstated, that has not happened.
CP: Can you tell me when they will call it in?
RH: Who?
CP: My family! They were supposed to call earlier. I just left home and they said it would be ready when I got here!
RH: You want ME to tell YOU when I think YOUR family will call in YOUR order?
CP: Yes! This logic works at my pharmacy for some reason.

Tuesday, September 9, 2014

Hardest Concept...

Most difficult explanation...Why you cannot get two Albuterol Inhalers at a time.

Why is this so difficult to understand?
A single Proair HFA inhaler contains 200 puffs. If your doctor instructed you to use 2 puffs every 4 hours then you could use up to 12 puffs in a day. At the maximum 12 puffs per day, this means your inhaler would last 16.67 days. Two inhalers would last 33.33 days. With me so far?

Now, your insurance will only pay for a maximum of a 30 day supply. Last I checked, 33.33 is greater than 30. Since we cannot simply prime 40 puffs out of 1 inhaler, we have to dispense a single inhaler. Yes, I do agree that your child may need an extra one for school.
Yes, he may need one for his soccer bag.
You are welcome to pay cash for the second inhaler.
You could have come in over the summer when he didn't needed it as frequently and refilled an extra one that would be designated as "The School Inhaler".
If he really uses it every 4 hours around the clock...then he only gets 4 hours of sleep which isn't good either.
You could plan ahead.
You could call your insurance for an override.
If your child really is that dependent upon his little albuterol inhaler then you know how to deal with this.
If he is actually using one inhaler every 16-17 days then perhaps he needs to be on another medication.
If he is NOT using one that frequently, then please don't fret. He can get the refill in about 12 days. I think he'll make it until then.


One of the more difficult conversations to have with a patient is about the "salt form" of their medications. It is tricky when one pharmacy puts the salt suffix on the label while another does not. Another problem occurs when one manufacturer's name gets truncated by the computer. It makes for some rather interesting inquiries.

"What do you mean it has a salt in it? I'm on a salt-free diet."
"What is H-C-I anyway?" (That's a lower case "L". It's Hydrochloride.)
"Last time my label said 'Metoprolol Tart. Now it says Succ.' Why does it say suck? I want the 'tarts' not the 'succs'."
"It says Ferrous Sulf. I'm allergic to Sulfa. Is that the same?"
"Can I take Calcium Citrate if I'm not allowed to eat grapefruit? It's a citrus."
"Salts? Like Bath Salts? I don't want that."

Monday, September 8, 2014

Why Insurances Suck

A short time ago a medication was on backorder. A real surprise, I know. At the time the only version available was a single manufacturer supplying blister packs. While they are a pain to deal with, at least we could provide the medication to our patients...until the pesky insurances got involved.
We received many "NDC not covered" rejects.
We called for overrides.
Some insurances were obliging, others were not.

This is one of those conversations:
Insurance Guy: How may I help you?
CP: I need to request an override for an NDC not covered rejection.
IG: For what reason?
CP: It is a blister-pack NDC and, unfortunately, the only one available.
IG: It's not covered.
CP: I know this, hence the rejection. Since we care about our patients, unlike their insurance companies, we were able to find the product for them and now are trying to dispense it to them.
IG: My computer shows this is not the only NDC available.
CP: But it is. We have been ordering this for 2 weeks and this is the only one we cold procure.
IG: The insurance won't pay for it since these others are available.
CP: Fine. Give me the NDCs your "magic computer" says are available.
<gives me 3 NDCs>
CP: Great. Those are 3 of the ones we have been ordering from all of our suppliers and, guess what? Not available.
IG: My computer shows they are.
CP: Well since your magic computer shows they are out there, can it also tell me where I can find them? Can it order them for me? Does it have real-time data that shows the inventory of every warehouse in the country?
IG: "No. It's not a magic computer." (Yes. I actually got him to say this.)
CP: Since I call and look online at the warehouses every day, and have been trying to order this for 2 weeks with no success, I think I would know better than your broken "magic computer" what is and is not available in the marketplace.
IG: "I don't have a magic computer." (He did it again.)
CP: Can you just please allow an override for this patient so I can get on with my day?
IG: No. My computer says it's available.
CP: Ugh. Okay. I'll call back and get someone who'll just put in the override with his magic computer.
IG: It's not...
CP: <click>

Called back. Got someone else. They put in the override. He agreed he doesn't have a magic computer either, but he also knew there were supply issues. It may have been exhausting, but it was fun.